POCUS in codes: Is that PEA really PEA?

So a few weeks ago, I asked the Twittersphere whether or not ultrasound should be readily available (if not outright used) in all codes. The answer was a resounding yes, and today’s article helps support that claim.

49 ICU patients with cardiopulmonary arrest (asystole or PEA) underwent intra-arrest bedside TTE. Based on Echo findings, these patients were classified as either asystole, PEA without cardiac contractility, or PEA with cardiac contractility. ROSC and survival to discharge, and survival to 180 days were evaluated. Of these 49 patients, 17 (35%) were in asystole based on Echo, 5 (10%) were in PEA without cardiac contractility, and 27 (55%) were in PEA with cardiac contractility. Rates of ROSC were 23.5% for those in asystole, 20% for PEA without cardiac contractility, and 70.4% for those in PEA with cardiac contractility. Survival to discharge (22%) and after 180 days (15%) only occurred in the PEA group with cardiac contractility. (Full disclosure- no word on CPC neurologic outcomes for survivors).

Now, this study looks at ICU arrests – clearly a bit different from OHCA cases we see in the ED, and perhaps intrigues me to suggest using cardiac POCUS in OHCA to stratify the futility of the resuscitation (This review found significant bias and large heterogeneity for prehospital sono usage for arrests). Nevertheless, with 15% 6-month survival in a group that without bedside sono you would call the code – its time to seriously consider the use of ultrasound (at least for) cardiac evaluation in all codes. For all of the things we do that fall into the “can’t hurt, might help” category, ultrasound in an arrest has to be high on the list.